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Test-Retest Apparent Diffusion Coefficient Reproducibility in Head and Neck Cancer Using a 1.5-T MR-Linac.

Brigid A McDonald¹, Dina El-Habashy¹, Renjie He¹

¹Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030.

Radiology. Imaging Cancer

|January 16, 2026

Summary

This summary is machine-generated.

This study assessed apparent diffusion coefficient (ADC) measurements in head and neck squamous cell carcinoma (HNSCC) using an MRI-guided linear accelerator (MR-linac). The MR-linac sequence showed acceptable reproducibility for detecting significant ADC changes in HNSCC radiation therapy.

Keywords:

Head/Neck MR-Diffusion Weighted Imaging Radiation Therapy Radiation Therapy/Oncology

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Area of Science:

Radiology
Oncology
Medical Physics

Background:

Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) measurements are crucial for assessing head and neck squamous cell carcinoma (HNSCC) response to radiation therapy.
MRI-guided linear accelerator (MR-linac) systems offer integrated imaging and treatment capabilities, but their reproducibility in quantitative MRI metrics like ADC needs evaluation.

Purpose of the Study:

To evaluate the reproducibility of ADC measurements in HNSCC using a 1.5-T MR-linac system.
To determine if lesion volume or time between scans affects ADC measurement reproducibility.

Main Methods:

Retrospective analysis of 37 HNSCC patients undergoing two echo-planar imaging DWI scans on a 1.5-T MR-linac before radiation therapy.
Calculation of mean and median ADC values and volumes, along with absolute and percent reproducibility coefficients (RCs).
Linear regression and F tests were used to assess the impact of lesion volume and scan interval on reproducibility.

Main Results:

The study included 34 primary tumors and 55 lymph nodes. Median ADC values for tumors and lymph nodes were comparable (approximately 1.16-1.19 × 10^-3 mm²/sec).
Reproducibility coefficients (RCs) for mean ADC were 0.365 × 10^-3 mm²/sec for tumors and 0.355 × 10^-3 mm²/sec for lymph nodes (percent RCs of 29.9% and 31.1%, respectively).
No significant correlation was found between lesion volume or scan interval and ADC reproducibility, though a trend towards poorer reproducibility in smaller lesions was observed.

Conclusions:

The 1.5-T MR-linac DWI sequence demonstrates acceptable reproducibility for detecting substantial ADC changes in HNSCC.
While generally reproducible, the system may miss some clinically significant, smaller ADC variations, particularly in smaller lesions.
Further optimization may be needed to enhance sensitivity for detecting subtle treatment response changes in HNSCC using MR-linac technology.